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Smoking

Several gay men’s health promotion agencies have expressed concern that gay men are more likely than the general population to smoke, with some offering smoking cessation courses. Because of these concerns, the survey, for the first time, included questions about smoking, even though tobacco use is not an HIV risk activity. The survey found that approximately 40% of gay men were smokers, and, compared to a recent UK government household survey, gay men at all ages were more likely to smoke than their heterosexual peers. This difference was particularly marked for men in their late teens, and in their early middle age.

Particularly high levels of tobacco consumption were reported by HIV-positive men, with 48% saying they smoked and 36% smoking ten or more cigarettes per day.

Although there has been concern, bordering on hysteria, about the use of crystal methamphetamine by gay men in the United Kingdom, the 2005 Gay Men’s Sex Survey, Consuming Passions has found that only 3% of gay men had taken the drug in the last year and that only 0.3% (49 men) took the drug on a weekly basis. Furthermore, the study found that users of methamphetamine, in common with gay men who used other recreational drugs, were users of several recreational drugs, or poly-drug users.

Men with the greatest numbers of sexual partners, according to the study, were the group most likely to express concern about their recreational drug use, with men who use ketamine, GHB, methamphetamine, or crystal, and crack cocaine the most likely to express concern.

The 2005 UK Gay Men’s Sex Survey, the ninth such analysis of gay men’s HIV risk behaviours, was completed by 16,500 gay men. It found that over 50% of gay men who had had anal sex in the previous year had not used condoms all the time, and that significant numbers of men had had unprotected anal sex that involved a risk of HIV. You can read a news report on sexual risk taking revealed by the study here.

Questions about smoking and drug and alcohol use were also included in the survey.

Poly drug use

With the exception of alcohol, the majority of men who used one drug also used at least one other. No drug, other than alcohol was exclusively used by more than 1% of gay men.

In particular, the study found that the users of less popular drugs – such as methamphetamine – were poly-drug users. Of the 3% of men who used this drug, 75% said they also used ecstasy and cocaine, two-thirds reported the use of poppers, Viagra an cannabis, half said they used GHB and speed, a third LSD, 25% tranquilisers, 20% crack cocaine and one-in-eight, heroin. Given this extent of poly-drug use, the investigators write, “ ‘crystal user’ is not a particularly helpful term.”

They add, “crystal methamphetamine has undoubtedly arrived in the UK. Its use was less widespread than most other drugs but increasing availability will probably result in increased usage. Early uptake of crystal has occurred among groups of men most likely to use other drugs and most crystal users were poly drug users.”

Drug and alcohol use

Some kind of drug – alcohol included – was used at least occasionally by the overwhelming majority of gay men. Unsurprisingly, alcohol was the most widely used drug, consumed by 92% of men participating in the study at some point during the previous year, with just over two-thirds reporting that they drank weekly.

After alcohol, poppers, which are legally available in the UK, were the drug most widely used, with 39% of men reporting some use, and 12% saying that they used them weekly.

Cannabis, ecstasy and cocaine were used by 17 - 18% of men in the previous twelve months, but only by 7%, 3% and 2% respectively on a weekly basis.

Ketamine was used by 9% of men at least once in the previous year, and by 1% of men weekly. Speed was also used by 1% of men weekly, but by 7% of men at some point in the year before.

Use of tranquilisers and GHB was reported by 4% of men in the previous year, with 1% saying they used either weekly. Both LSD and methamphetamine were used by 3% of men at least once in the year before the survey, but only 0.3% used either of these drugs on a weekly basis. Only 1% of men used either heroin or crack cocaine, with very small numbers reporting weekly use.

The authors of the report comment: “While crystal may have particularly spectacular addictive qualities it remains hard to see why it occupies such a large part of current drugs debate, except by reference to faddishness, and the tendency to generate moral panic among both the HIV sector and media.”

Drug use and HIV status

HIV-positive men were more likely to use every drug, with the exception of alcohol. HIV-negative men showed greater use of every drug than men who had never tested for HIV.

Factors associated with drug use

Use of alcohol was equally common across the UK, except for Northern Ireland where fewer gay men reported drinking.

Gay men in London were most likely to use every recreational drugs, with the exception of speed, the use of which was particularly common amongst gay men in northern England and Northern Ireland.

Given that men in their 20s and 30s are most likely to use the commercial gay scene, it should come as no surprise that the survey revealed that men in these age groups were the heaviest users of drugs.

Education was associated with the use of particular drugs. Men with the most years of education post-16 were most likely to use cocaine, and those with the least education the most likely to use poppers and speed.

Men with higher incomes were particularly likely to drink, use poppers, as well as take Viagra, ecstasy, ketamine and GHB. Lower income was associated with use of cannabis, speed and LSD.

Drug use and sexual activity

An association was found between drug use and numbers of sex partners. Men who reported having over 30 partners a year had the highest consumption of every drug except alcohol. Although only 1% of men with between 12 – 29 partners reported use of methamphetamine, this increased to 4% for men with 30 or more partners. However, it should be noted that the number of such men in the sample was extremely low.

Men who thought that they had above average attractiveness were more likely to use every drug than men who rated their attractiveness as average or below.

Concerns about smoking, and alcohol and drug use

Of the gay men who reported smoking, 68% said they wished to stop. Concerns about drinking were expressed by 30% of all alcohol users, and the likelihood of expressing concern increased with the frequency of drinking, with 36% of those who drank weekly or more saying they were worried about their use of alcohol.

With the exception of poppers, cannabis and Viagra, a quarter or more of the users of all drugs said they sometimes worried about their drug use. Men who used ketamine (38%), GHB (38%), methamphetamine (39%) and crack (40%) were most likely to say that their drug use concerned them.

HIV-positive men were most likely to say they were worried about smoking, whereas HIV-negative men were more likely to report worries about the use of every other substance.

Concern about drug use increased with numbers of sexual partners, with men who had over 30 partners a year most likely to say that their drug use behaviour concerned them.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.